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Introduction: Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient‐held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self‐management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low‐ and middle‐income countries are critical in policy decisions but have rarely been researched. Aim: This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala. Methods: A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis. Results: Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision‐making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies. Conclusion: Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self‐management. Patient and Public Involvement: Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context. [ABSTRACT FROM AUTHOR]

Background: Reaching hard to reach populations is key to reduce health inequities. Despite targeted interventions, status of crucial public health indicators like neonatal and maternal mortality is still far from optimal. Complex interplay of social determinants can influence both communities and health care workers to effectively access each other. We argue that culturally sensitive and contextually relevant healthcare provision has potential to increase health care utilization by the vulnerable communities living in remote areas. Methods: The study is an exploratory case study using rapid ethnographic techniques to understand the interplay of social determinants in hard to reach areas of Odisha state, India. We used in-depth interviews, focus group discussion, participatory action research and key informant interviews as tools for data collection. The analysis of data has been guided by thematic analysis approach. Results: We found that there are further layers within the designated hard to reach areas and those can be designated as-i) extremely remote ii) remote and iii) reachable areas. Degree of geographic difficulties and cultural dynamics are deciding the 'perceived' isolation and interaction with health care providers in hard to reach areas. This ultimately leads to impacting the utilization of the facilities. At extremely remote areas, felt health needs are mainly fulfilled by traditional healers and ethno-medical practices. In reachable areas, people are more prone to seek care from the public health facilities because of easy accessibility and outreach. Being in middle people in remote areas, diversify health care seeking depending upon social (e.g. patient's gender) economic (e.g. avoid catastrophic expenditure) and health system (timely availability of health human resources, language barriers) factors. Conclusion: Our research highlights the need to value and appreciate different worldviews, beliefs and practices, and their understanding of and engagement with the pluralistic health care system around them. Other than pursuing the 'mainstreaming' of a standardized health system model across hard to reach areas, strategies need to be adaptive as per local factors. To handle that existing policies need revision with a focus on culturally sensitive and contextual care provision. [ABSTRACT FROM AUTHOR]

Background: Rastriya Kishor Swasthya Karyakram (RKSK) is a holistic approach implemented for betterment of adolescent health. Barriers in the implementation can be identified by conducting the situational analysis of any program. The present study is a part of the multi-centric study conducted at Sabarkantha district for situational analysis of RKSK. To assess the implementation of various components under RKSK at various levels of health facilities, 2) to identify the barriers faced by services providers in RKSK implementation, and 3) to identify the perception of beneficiaries regarding RKSK. Materials and Methods: A Cross-sectional study using a mixed method approach was conducted to review the implementation of the RKSK program at Sabarkantha district. In-depth interview of health personnel involved in implementation of RKSK was conducted using pre-structured and pre-tested interview guide. Ongoing sessions of Adolescent Friendly Health Clinics (AFHCs) were examined, and exit interview of adolescents was conducted. Adolescents residing within limits of the defined facility were also interviewed. Frequency and percentages were used for descriptive analysis, and a thematic qualitative analysis approach was used for qualitative aspects. Results: RKSK was implemented successfully at Primary Health Centers. Infrastructure for AFHC was inadequate particularly at higher care facilities. Weekly Iron Folic Acid Supplementation (WIFS) was successfully implemented in the district. Overall sessions conducted at AFHC were found to be satisfactory. Adolescents interviewed in the community were satisfied with the services delivered to them under RKSK. Conclusion: For better implementation of RKSK, there is a need to focus on certain issues such as inadequate infrastructure of AFHCs, the lack of trained counselors, unavailability of sanitary pads, and inadequate participation of adolescents from the community in availing RKSK services. [ABSTRACT FROM AUTHOR]

Background: The concomitant availability of services and care with the rise in the older population in India does not commensurate with their health care needs, thus affecting their well-being and quality of life (QoL). The Indian State of Kerala, epidemiologically and demographically advanced and often compared with developed countries, has the highest number of older persons. It also ranks top in the human development index in the country. This study seeks to explore the factors influencing QoL among older persons in Kerala, a state located within a low middle-income country. Materials and Methods: Qualitative methods using exploratory design were employed. Ten focus group discussions and ten face-to-face in-depth interviews were conducted in two districts of Kerala. The data were thematically analyzed using a framework approach. Results: The study explored a multitude of factors influencing QoL among older people in Kerala. The themes that emerged from the study were, "Financial securities and insecurities," "psychological well-being," "lifestyle," "health-care utilization," and "social engagement." Conclusion: The current study findings have explored the changing importance or value of the factors attributed to older persons' QoL in an advanced population within a low middle-income country such as India. [ABSTRACT FROM AUTHOR]

Background: Palliative care has proven over time that it can help prolong life spans with the use of hospices. The literature reports that most patients with cancer are diagnosed in the later stages and since there is no cure, they will require palliative care at some point during their illness. However, most developing countries, including India, have failed to establish hospices; as a result, large numbers of cancer patients are still deprived of palliative care. To initiate better access to hospices, it is important to understand the benefits of the same. Therefore, the present study aims to explore the advantages of hospice care from the perspectives of advanced cancer patients living in hospice centres. Methods: The present study uses the method of exploratory research. Using purposive sampling, 8 participants living in a hospice in Bengaluru, India were selected and semi-structured interviews were conducted to collect data from the patients. This data was analysed using thematic analysis. Any underlying patterns were determined to identify the evident themes that emerged from the data. Results: After thematic analysis, 4 themes were identified, namely, pain management, altruism, a good death, and overall satisfaction. Within some themes, there were specific sub-themes that have been illustrated using direct quotes from the interviews. Conclusion: The findings of this study suggest that hospice centres play an important role in helping patients to come out of the trauma during the advanced stages of cancer. A sense of relief can be given to the patient by implementing palliative care. This is possible by building more hospice centres in the country where all individuals, irrespective of their financial status, can opt for the service. Having palliative care will provide dignified death to the patients. [ABSTRACT FROM AUTHOR]

Background: Internal labour migration is an important and necessary livelihood strategy for millions of individuals and households in India. However, the precarious position of migrant workers within Indian society may have consequences for the health of these individuals. Previous research on the connections between health and labour mobility within India have primarily focused on the negative health outcomes associated with this practice. Thus, there is a need to better identify the determinants of internal migrant health and how these determinants shape migrant health outcomes. Methods: An exploratory mixed methods study was conducted in 26 villages in the Krishnagiri district of Tamil Nadu. Sixty-six semi-structured interviews were completed using snowball sampling, followed by 300 household surveys using multi-stage random sampling. For qualitative data, an analysis of themes and content was completed. For quantitative data, information on current participation in internal labour migration, in addition to self-reported morbidity and determinants of internal migrant health, was collected. Morbidity categories were compared between migrant and non-migrant adults (age 14-65 years) using a Fisher's exact test. Results: Of the 300 households surveyed, 137 households (45.7%) had at least one current migrant member, with 205 migrant and 1012 non-migrant adults (age 14-65 years) included in this study. The health profile of migrant and non-migrants was similar in this setting, with 53 migrants (25.9%) currently suffering from a health problem compared to 273 non-migrants (27.0%). Migrant households identified both occupational and livelihood factors that contributed to changes in the health of their migrant members. These determinants of internal migrant health were corroborated and further expanded on through the semi-structured interviews. Conclusions: Internal labour migration in and of itself is not a determinant of health, as participation in labour mobility can contribute to an improvement in health, a decline in health, or no change in health among migrant workers. Targeted public health interventions should focus on addressing the determinants of internal migrant health to enhance the contributions these individuals can make to their households and villages of origin. [ABSTRACT FROM AUTHOR]